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WORKERS' COMPENSATION DECLARATION <br />I _Steve Hernandez <br />(Named tle) <br />following declaration: <br />hereby affirm under penalty of perjury, the <br />I certify on behalf of WaterWisePro Training that during the term of my <br />ICnneitltanYCompany Name) <br />contract for water operator training services with the City of Santa Ana, I will <br />not employ any person in any manner so as to become subject to tte workers' - <br />compensation lavers of Califomia, and agee that if I should become subject to the <br />workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith <br />comply with those provisions and provide proof of workers' compensation coverage. <br />DATE: April 18, 2017 <br />By: _ WaterVllisePro Training <br />Name: Steve Hernandez <br />Title: Instructor <br />Telephone: _ 831.750.9113 <br />WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS <br />UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES <br />AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN <br />ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR <br />1N SECTION 3706 OF THE LABOR. CODE, INTEREST, AND ATTORNEY'S PEES. <br />